Waltham, MA – July 8, 2025 – A new study by the Workers Compensation Research Institute (WCRI) identifies detailed factors associated with high-cost claims involving rotator cuff disorders, based on an analysis of clinical characteristics and treatment patterns specific to these injuries.

“This study offers a deeper understanding of how various levels of rotator cuff tears and their surgical patterns contribute to elevated medical costs. From a medical and claims management perspective, these are challenging injuries, and the study’s results could inform effective care strategies and resource utilization,” said Sebastian Negrusa, WCRI’s vice president of research.

The study, Patterns and Trends of High-Cost Claims Involving Rotator Cuff Disorders, examined the association between condition-specific factors and the likelihood of a claim becoming high cost (defined as medical payments exceeding $65,000 within 36 months of injury).

The following are among the questions the study addresses:

• What are the specific factors contributing to high medical payments for rotator cuff injuries?
• Are patterns of medical care consistent with guideline recommendations and expected medical practice regarding timing of surgery and pre- and postoperative nonsurgical treatments?
• To what extent do degenerative conditions and comorbidities influence treatment decisions and contribute to elevated costs?

The analysis is based on nearly 50,000 rotator cuff disorder claims drawn from a dataset of over 930,000 lost-time claims across 32 states. These claims involved injuries occurring between October 2015 and March 2019, with medical billing and treatment data tracked for three years postinjury.

The full report is available to WCRI members and can be purchased by nonmembers here. The report was authored by Dongchun Wang, Randall D. Lea, and Kathryn L. Mueller.

ABOUT WCRI

The Workers Compensation Research Institute (WCRI) is an independent, not-for-profit research organization based in Waltham, MA. Organized in 1983, the Institute does not take positions on the issues it researches; rather, it provides information obtained through studies and data collection efforts, which conform to recognized scientific methods. Objectivity is further ensured through rigorous, unbiased peer review procedures. WCRI's diverse membership includes employers; insurers; governmental entities; managed care companies; health care providers; insurance regulators; state labor organizations; and state administrative agencies in the U.S., Canada, Australia, and New Zealand.

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